What the science says about the Trump administration’s new vaccination schedule

To date, the Trump administration has left its largest imprint on America’s childhood immunization schedule. Among the changes, the government timetable downgrades the once universally recommended shots in favor of a designation called “shared clinical decision-making.” This change affects vaccines that protect against diseases such as hepatitis A, rotavirus and influenza.

This may not seem like a big change, just a suggestion to have a conversation with a doctor. But “shared clinical decision-making” has a specific meaning in terms of vaccines, implying that the calculation of benefits and risks is unclear, even if it is not the case for classified shots. This change adds to the confusion and doubt that the current administration has injected into vaccine policy in the United States.

“It’s really uncharted territory,” says Jake Scott, an infectious disease physician at Stanford University School of Medicine. “Transferring these vaccines to a shared decision-making process does not reflect scientific uncertainty, but it creates it.”

The changes, announced by the administration on January 5, do not follow long-standing protocol to consider updates to the U.S. childhood immunization schedule. The traditional process of lengthy scientific review results in recommendations made by the Advisory Committee on Immunization Practices. Without using this open, deliberate process, “it’s really hard to have confidence in any of the proposed changes,” says infectious disease pediatrician Lori Handy, associate director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

No new evidence has been presented to support the reduction of universally recommended vaccines. These changes “are not being made in the best interest of children, because more children will inevitably get sick,” Handy says.

Although the administration says the changes put the United States in a consensus among peer countries’ vaccination schedules, “vaccine policy is not universal,” Scott says. “It must take into account how health care is actually delivered in a given country,” including who has access to it, what the infrastructure looks like and where the gaps are, as well as epidemiological differences between countries.

Shared clinical decision making

The administration reclassified vaccines that protect against hepatitis A, hepatitis B, meningococcal disease, rotavirus, influenza and COVID-19 from universal recommendation to shared clinical decision-making. This category is inappropriate for these vaccines, Scott says. These are situations in which “individual factors significantly modify the risk-benefit calculation” and where the benefit to the population is uncertain. Handy says the category covers circumstances in which medical and social risk factors “are so nuanced that it is difficult to make a clear routine recommendation.”

For example, in 2019, ACIP recommended shared clinical decision making for adults aged 27 to 45 when considering the human papillomavirus, or HPV, vaccine. The HPV vaccine is universally recommended for preteens because it is most effective in preventing HPV-related cancers before exposure to the virus. Many adults have probably already encountered the virus. But an unvaccinated adult who tests negative for HPV and begins a new sexual relationship could be at risk of further exposure. In this case, an HPV vaccine would be protective.

Shared clinical decision-making is intended for occasions “where the risk-benefit calculation is close enough that individual factors can tip it one way or the other,” Scott says. “But this is not the case for any of these vaccines” which have been reclassified in the childhood vaccination schedule.

“Each vaccine moved to shared decision-making has undergone rigorous evaluation,” he says. “For each of these, the benefits have been shown to outweigh the risks. » And the evidence supports a universal recommendation.

Here’s a closer look at several diseases for which vaccines have been moved to shared clinical decision-making.

Hepatitis A

Hepatitis A is a highly contagious virus that spreads from person to person or through eating contaminated food or drinks. “We know our food supplies are at risk of a hepatitis A outbreak,” Handy says. Having a shared decision-making conversation about the risks of contracting hepatitis A is essentially like asking someone if they’re going to eat, she says. “It’s just not a practical conversation to have.”

Hepatitis A causes liver disease that usually goes away but can lead to liver failure. Cases of hepatitis A have decreased significantly thanks to the introduction of vaccination. In 1999, the vaccine was recommended for children living in states with the highest rate of new cases, and then recommended nationwide in 2006. Children routinely receive a two-dose series between 12 and 23 months of age.

The incidence of hepatitis A has fallen by 12 cases per 100,000 in 1995 has 0.7 per 100,000 in 2022. People can accept the risks of children eating a variety of foods “because we know they’re protected” from vaccination, Handy says, “and that’s just something you can do before they’re at risk.”

Hepatitis B

The need to provide protection prior to exposure is why the the first dose of hepatitis B vaccine has long been universally recommended at birth for newborns. These infants could be exposed during birth or shortly after and are at particularly high risk of developing chronic hepatitis B, an incurable disease that damages the liver and increases the risk of liver cancer.

One in four children with chronic hepatitis B will die prematurely from complications of the disease. “All children are at risk for hepatitis B,” Handy says. The virus is very contagious “and we do not know who in the population is affected by it”. But the universal birth dose recommendation was removed by the current administration in December.

Meningococcal disease

Meningococcal disease outbreaks, caused by the bacteria Neisseria meningitidis are unpredictable and an infection can be fatal in just 48 hours. “This is such a devastating infection that we can prevent it,” Handy says. Invasive meningococcal disease causes meningitis, an inflammation of the membranes surrounding the brain and spinal cord, or sepsis, a blood infection. And the case fatality rate may be highranging from 4 to 20 percent in an analysis of 40 studies. A few 10 to 40 percent of survivors can suffer long-term consequences, including hearing loss and amputation.

Meningococcal vaccination is universally recommended for adolescents, as this group is a major vector for the spread of the bacteria. Any teen who gathers in close quarters with other teens, shares drinks, hangs out in bars, dorms or other crowded places is at risk, Handy says. So basically, all teenagers.

Flu

For the flu, the question of what puts someone at risk is also not complicated: “Do you have contact with other people during the winter?” Handy said. “If so, you deserve a flu shot.”

The administration’s re-designation of the flu vaccine toward shared clinical decision-making from a universal recommendation for children 6 months and older comes after one of the worst flu seasons for children, 2024-2025. There was more child deaths from flu280, than in any non-pandemic flu year since record-keeping began in 2004, researchers reported in September in Weekly Morbidity and Mortality Report. Vaccination status data was available for 208 of these children: 89 percent were not fully immunized against influenza.

This season’s flu vaccine does not match a late-season flu strain that is causing many cases. But it still offers children and adolescents 72 to 75 percent efficiency against emergency room visits and hospital admission, researchers reported in November in Eurosurveillance. The analysis focused on data from autumn 2025 in England. In the United States, there have been Nine pediatric flu-related deaths reported so far this season, from January 5.

Rotavirus

For American children, rotavirus was the leading cause of severe acute gastroenteritis, an infection of the gastrointestinal tract that leads to vomiting, diarrhea, dehydration and often hospitalization.

Since vaccination was universally recommended in 2006, hospitalizations related to this disease have decreased significantly. Before vaccination, the hospitalization rate for gastroenteritis was 76 per 10,000 in children under 5 years old. dropped to 34 per 10,000. Without routine vaccination, there will be an increase in rotavirus infections, Handy says. “We’ll end up seeing more kids hospitalized for dehydration and vomiting who really don’t need to experience this.”

What parents and providers can do

As the administration rolls back decades of robust vaccine policy, parents and providers can look to the American Academy of Pediatrics Childhood Immunization Schedulewith which the Centers for Disease Control and Prevention’s schedule was once aligned. “Clinicians can continue to follow the schedule established by the AAP 100%,” Handy says.

Scott says, “When the federal government and pediatricians disagree, I would say trust the pediatricians. »

The science that supported the universal recommendation of these vaccines last month “is the same science that exists today,” he says. But now that the administration has recategorized the approach to these shots, Scott would advise parents to be proactive, making sure to ask their providers during pediatric appointments if their child is up to date on vaccines. “Unfortunately, the burden will now be heavier on parents.” This burden should fall on public health institutions like the CDC, “but these institutions are failing and so parents must fill the void.”