How Changes to US Vaccine Policy Could Impact You

As we enter 2026, U.S. vaccine policy is undergoing one of its most dramatic transformations in decades, with profound implications for public health, trust in science, and the well-being of children and communities. These changes come on the heels of our declaration of Health in All Policies as The Medical Care Blog’s theme for 2026, which calls for evidence-based, equitable public health policy across sectors. Here’s the latest on what’s changed, why it matters, and the debate it has ignited.

From scientific assessment to policy action

On January 2, 2026, the Department of Health and Human Services (HHS) released a comprehensive scientific assessment of the U.S. childhood and adolescent immunization schedule[[pdf], comparing it to the practices of other developed nations. The assessment’s core conclusion was that the United States recommends more vaccines, across more ages, than peer nations without superior immunization rates. This framing justified the rethinking of long-standing vaccine recommendations.

Just three days later, on January 5, the acting director of the Centers for Disease Control and Prevention signed a decision memo directing formal implementation of changes based on that assessment. The new policy restructures the categories of vaccine recommendations and even the diseases included in those recommendations.

The decision memo and subsequent reports

According to the decision memo itself[[pdf]and related coverage, the CDC has shifted from a single, universal childhood immunization schedule toward a three-tiered framework:

1. Vaccines recommended for all children: including measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Hib, pneumococcal disease, HPV, and varicella (chickenpox).
2. Vaccines recommended only for certain high-risk groups: e.g., RSV, hepatitis A/B in specific contexts, meningococcal strains.
3. Vaccines based on “shared clinical decision-making”: meaning parents and clinicians jointly decide on vaccines such as influenza, COVID-19, rotavirus, and others, rather than having blanket recommendations.

These changes reduce the number of diseases for which all children are routinely advised to be vaccinated. It changes the recommendation from roughly 17–18 diseases under prior schedules to around 11 core recommendations. Updated policy no longer universally recommends vaccines against hepatitis A, hepatitis B, rotavirus, influenza, COVID-19, RSV, and certain meningococcal diseases. Instead, the updated language points to risk-based or clinician-patient shared decision-making. Importantly, HHS and CDC officials have asserted that all vaccines remain available and covered by insurance even if not universally recommended.

Implications & potential impacts

Public health experts and pediatric clinicians have raised significant concerns about the practical and epidemiological consequences of these changes:

• Confusion among parents and providers: Shifting from clear universal recommendations to more nuanced decision categories creates complexity and communication challenges that may discourage vaccination.
• Risk of declining immunization coverage: Vaccines that are no longer broadly recommended have historically prevented millions of hospitalizations and thousands of deaths. Reducing their default status could decrease uptake and re-expose populations to preventable disease.
• Erosion of public trust: Without transparent scientific justification and broad expert consensus, these changes risk undermining trust in public health guidance. And trust is a key concern for achieving Health in All Policies.
• Broader impact on vaccine hesitancy: The timing coincides with increasing hesitancy and outbreaks (e.g., measles) that require population immunity thresholds near 95%, goals that may be harder to achieve without robust standard recommendations.

For parents and clinicians navigating these changes, thoughtful engagement and clear communication are essential, but will be difficult without consistent national leadership.

Pushback from states and health organizations

Nearly two weeks after the CDC’s announcement, a growing coalition of states and health organizations have publicly rejected the new guidance, explicitly stating they will not follow the revised CDC schedule. As of mid-January, at least 17 states including: California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Pennsylvania, Vermont, Washington, and Wisconsin, have affirmed continued reliance on the American Academy of Pediatrics’ long-standing vaccine recommendations rather than the new federal guidance.

State public health leaders have called the federal changes “reckless,” dangerous, and likely to amplify confusion, especially amid ongoing measles and whooping cough outbreaks.

In some cases, states have formed interstate health alliances (e.g., the West Coast Health Alliance, the Northeast Public Health Collaborative) to jointly issue and coordinate evidence-based immunization guidance independent of CDC policy.

Consensus evidence-based recommendations

Leading medical organizations continue to emphasize routine, evidence-based immunization schedules grounded in rigorous science.

The American Academy of Pediatrics (AAP) strongly recommends on-time, routine immunization for all children and adolescents, advocating for schedules that maximize disease prevention, community immunity, and consistent clinical practice. The National Foundation for Infectious Diseases (NFID) and its partners endorse evidence-based vaccine recommendations across the lifespan, reflecting the best available science on safety and efficacy.

Joint letters from professional societies (including AAP, American Medical Association, American College of Obstetricians and Gynecologists, and others) urge federal leaders to reaffirm transparent, evidence-driven policy processes and to resist adopting schedules designed for other countries without contextualizing U.S. epidemiology and risks. These editorials and policy statements underscore the ongoing need for clear, evidence-based communication in an era of rapid policy shifts.

Aligning policy with evidence and American interests

Public health decisions should be grounded in evidence, equity, and the best interests of U.S. communities. That is a central pillar of Health in All Policies. While the CDC’s stated aim was to align U.S. vaccine policy with other countries’ recommendations, epidemiology and context matter: U.S. population characteristics, healthcare access, and disease transmission dynamics differ significantly from those in smaller, universal-health-care systems.

To control measles and other preventable diseases, the U.S. must strive for population immunity near the 95% threshold, a target supported by decades of evidence and observed outcomes. Achieving and maintaining this level of immunity requires protecting and reinforcing evidence-based vaccine schedules, clinical best practices, and core public health infrastructure, not eroding them. Putting American health first means upholding immunization policies that reflect solid evidence, transparent processes, and the unique health needs of the U.S. population.

Equally concerning is how this policy change was made. This was not a transparent, open, and independent review process comparable to the long-standing work of ACIP and its external scientific advisory structures. There was no public docket. There was no visible systematic evidence synthesis. Nor was there open debate among multidisciplinary experts or clear explanation of how decades of accumulated safety, effectiveness, and population-level impact evidence were weighed. This absence of procedural transparency is not just a governance failure. It is a public health risk.

Where Do We Go From Here?

Vaccine policy operates not only through biology, but through trust, norms, and institutional credibility. Abruptly weakening long-standing recommendations without a transparent evidentiary process invites confusion. It accelerates erosion of confidence. It creates precisely the conditions under which preventable disease resurgence becomes more likely. In a country already struggling to maintain adequate measles, pertussis, and influenza coverage, this kind of opaque policymaking is not a neutral experiment. It is a gamble with predictable and potentially severe consequences.

The early weeks of 2026 have ushered in seismic shifts in U.S. vaccine policy. This has cascading effects across clinical practice, public trust, and state–federal public health coordination. As policymakers, clinicians, and families navigate this terrain, the principles of Health in All Policies should guide them.

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Ben King is an Editor for the Medical Care Blog. He is an epidemiologist by training and an Assistant Professor at the University of Houston’s Tilman J Fertitta Family College of Medicine, in the Departments of Health Systems and Population Health Sciences & Behavioral and Social Sciences. He is also a statistician in the UH Humana Integrated Health Systems Sciences Institute at UH, a Scientific Advisor to the Environmental Protection Agency, and the President of Methods & Results, a research consulting service.

His own research is often focused on the intersection between poverty, housing, & health. Other interests include neuro-emergencies, diagnostics, and a bunch of meta-topics like measurement validation & replication studies. For what it’s worth he has degrees in neuroscience, community health management, and epidemiology.