CDC removes six diseases from childhood vaccination schedule, causing concern among clinicians
The Centers for Disease Control and Prevention has reduced the list of recommended immunizations to 11 from the 17 the agency previously recommended. While Trump administration officials say the revision brings the U.S. in line with other developed countries, some in public health believe it unnecessarily puts children at risk for preventable diseases.
CDC vaccine recommendations typically emerge from a deliberative process that includes a review of the scientific literature and clinician input through meetings of the agency's Advisory Committee on Immunization Practices (ACIP). President Trump directed the heads of the Department of Health and Human Services and the Centers for Disease Control and Prevention to review childhood vaccination practices after he issued a memo in December removing six vaccines from the childhood vaccination schedule.
Jim O'Neill, acting director of the Centers for Disease Control and Prevention, approved the changes to the vaccination plan on Monday. The decision is based on a report written by Tracy Beth Høeg, acting director of the FDA's Center for Drug Evaluation and Research, and Martin Kulldorff, chief science and data officer for HHS assistant secretary for planning and evaluation. Kulldorf previously served as ACIP president. He was one of the new ACIP members selected by U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. last June after Kennedy fired the entire committee.
The report concluded that vaccines should be withdrawn for six diseases: respiratory syncytial virus (RSV), hepatitis A and B, meningococcal B and ACWY, and dengue fever. For high-risk groups, such as those with weakened immune systems or underlying health conditions, these vaccine recommendations remain in effect. But for others, the decision to get vaccinated will be based on “shared clinical decision-making,” in which patients and their parents consult with their doctors.
“Each disease included in the U.S. childhood immunization program poses a health risk, but the level of threat varies by disease and sometimes by individual underlying risk factors,” the Centers for Disease Control and Prevention decision memorandum states. “The presence of a vaccine does not mean it is automatically appropriate for every child, nor does it necessarily justify universal vaccination.”
Remaining vaccines in the program include measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, Haemophilus influenza type B (Hib), pneumococcal disease, human papillomavirus and varicella (chickenpox) vaccine. The report points out that for these diseases, the international community has reached broad consensus and recommends that all children be vaccinated. But for the HPV vaccine, the CDC now supports giving children a single dose instead of two. The decision memo noted that Australia, parts of Canada, Ireland, Spain and the United Kingdom have changed their recommendations to one dose. These countries were selected as one of 20 equivalent developed countries to be compared with the United States
Høeg and Kulldorff's report concluded that the United States was an outlier both in the number of diseases included in its childhood vaccination program and in the total number of vaccine doses recommended. Denmark figures prominently in the report, which says it will become the first country of its kind to lift universal recommendations for Covid-19 vaccines for children in 2022. The report also noted that Denmark was able to vaccinate children against 10 diseases using only 30 total doses, a feat achieved through the use of multivalent vaccines.
Dr. Robert Hopkins, medical director of the National Foundation for Infectious Diseases (NFID), said it would be inappropriate to compare the U.S. childhood immunization program with those in Denmark or other countries because of differences in population size, diversity, access to health care and infectious disease risks.
“These differences are important,” Hopkins said in an email. “U.S. immunization policy must be guided by a transparent, evidence-based process and grounded in U.S. epidemiology and real-world risks. As we are already seeing signs of a severe respiratory illness season, now is not the right time to make changes that are not supported by clear evidence.”
Hopkins noted that 280 children died from the flu last flu season, the highest number in more than a decade. Additionally, RSV remains the most common cause of hospitalization among infants in the United States. NFID continues to recommend annual influenza vaccination for everyone 6 months and older and RSV vaccination for all infants whose mothers were not vaccinated during pregnancy.
Dr. Sandra Adamson Freihoff, a member of the American Medical Association's board of directors, said in a prepared statement that the organization is “deeply concerned” about the changes to the childhood immunization schedule.
“Changes of this magnitude require careful review, expert and public input, and clear scientific evidence,” she said. “This level of rigor and transparency was not part of this decision. When long-standing recommendations are changed without a robust, evidence-based process, it undermines public trust and puts children at unnecessary risk of preventable disease.”
Fryhofer added that the scientific evidence for the vaccine remains unchanged and the American Medical Association supports the continued immunization of children as recommended by national medical professional societies.
Susan Dentzer, president and CEO of American Physicians Group (APG), said the administration’s revisions to the vaccination schedule ignore scientific evidence about the safety and effectiveness of vaccines and long-standing U.S. recommendations on immunization.
“As APG has emphasized time and time again, vaccines are the key to prevention, and prevention is the key to value-based care,” Danzig said in an emailed statement. “The administration’s actions are not only dangerous, they threaten the efforts of our physician community and many others to provide health care that is fully accountable to cost and quality.”
Photo: Megan Varner/Bloomberg via Getty Images
