Health Care Professionals Push Back as CDC Revises Routine Childhood Vaccination Guidance

In the first weeks of 2026, the CDC began updating its federal immunization schedule, reducing the number of immunizations under the routine childhood vaccination program from 17 to 11. Individual states, rather than the federal government, have the authority to mandate vaccinations. However, recommendations from federal agencies like the CDC strongly influence state vaccination policies and requirements.^1-3

Vaccines that remain universally recommended for all children include DTP (diphtheria-tetanus-pertussis [whooping cough]); Hib (Haemophilus influenzae type b); pneumococcal vaccines; polio; MMR (measles-mumps-rubella); varicella (chickenpox); and a single dose of HPV (human papillomavirus). Vaccines for rotavirus, COVID-19, influenza, hepatitis A virus, hepatitis B virus, and meningococcal disease are no longer considered universally routine but are instead recommended based on individual risk and shared decision-making between families and health care providers.^1,2

The changes, announced by former acting CDC director Jim O’Neill, were effective immediately and mark a significant shift in federal vaccine policy, representing one of the most notable public health changes under US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr, who has long advocated for reducing the number of childhood vaccinations.^1-3

“This shift represents a move away from population-level prevention toward individualized risk assessment, and that has serious implications in the US context,” Jeffery Goad, PharmD, MPH, professor of pharmacy practice at the Chapman University School of Pharmacy in Irvine, California, said in an interview with Pharmacy Times.⁴

Medical Groups Reaffirm Evidence-Based Vaccine Guidance

The changes were implemented without a recommendation from the CDC’s Advisory Committee on Immunization Practices and without endorsement from major medical or pharmacy organizations, including the American Academy of Pediatrics (AAP) and the American Pharmacists Association.⁴

On February 5, 2026, the AAP released its 2026 immunization schedule, emphasizing the importance of adhering to recommended childhood and adolescent vaccines. The schedule is endorsed by the American Medical Association (AMA), and approximately a dozen other physician and health professional organizations, collectively representing more than 1 million physicians, pharmacists, and pediatric health professionals.^5,6

Despite the federal recommendations, many physicians are continuing to rely on scientific consensus and professional associations rather than shifting federal guidance, leading to a disconnect between policy and practice.⁷

“The associations, the AMA and AAP, have already come together to say they are going to follow the evidence-based guidelines. There is this notion of shared decision-making for the vaccines that have been removed from the schedule, which leaves a lot of opportunity for variation in how it is explained, communication skills, and the relationship between the provider and the parents. You can see that there is opportunity for negative implications by doing that,” Lora Sparkman, MSN, RN, vice president of patient safety and quality for Relias, said in an interview with Pharmacy Times.⁷

Clinicians Cite Disconnect Between Policy and Practice

Sparkman cautions that greater variability in vaccine decision-making could undermine patient trust, equity, and safety, especially for vulnerable populations.⁷

“It puts clinicians and pediatricians in a tough position, because they are trained to follow evidence-based guidelines. What is happening, and what has happened at the federal level, is a massive upheaval of traditional practice around immunization schedules,” Sparkman said.⁷

One major concern is the growing inconsistency that is likely to persist without alignment among federal agencies, states, and payers. Ongoing education and training are essential to ensure providers remain current. Because not all pediatricians are actively involved in professional associations, Sparkman noted that health systems must take an active role in monitoring emerging vulnerabilities and responding promptly with science-based, evidence-driven practices.⁷

“[The current situation] is adding to the chaos around guidance and evidence-based guidelines. When that is further disrupted, it creates more variation, and when you vary from evidence-based practice standards, more people slip through the cracks. We are going to see increased outbreaks where these vaccines had been doing their job effectively,” Sparkman said.⁷

Measles Cases Surge Amid Declining Vaccination Rates

Ongoing measles outbreaks around the country are a case study in the effects of decreased vaccination rates. There were more than 2000 cases of measles in 2025, and outbreaks are ongoing in several states, driven by low MMR vaccination rates.

In the most widespread outbreak to date, the South Carolina Department of Public Health has reported 950 cases of measles centered around Spartanburg County as of February 13, 2026. Most cases typically occur among close contacts of known infections; however, the growing number of public exposure sites suggests that measles is circulating in the community. This is increasing the risk of exposure and infection among individuals who lack immunity from vaccination or prior infection.^8,9

The rise in cases has created concern among federal health officials. In February 2026, Centers for Medicare & Medicaid Services Administrator Mehmet Oz, MD, MBA, urged individuals to get the MMR vaccine, emphasizing that there will never be a barrier to US adults getting access to the measles vaccine. In contrast, however, Kennedy made a mixed statement about the measles vaccine in the same week, calling it crucial for preventing potentially deadly disease while also raising safety concerns and emphasizing that vaccination is a personal choice.^8,9

“When vaccines move from routine to shared decision-making categorization, many families interpret that shift as uncertainty or reduced importance. Even modest declines in uptake can lead to a resurgence of vaccine-preventable diseases, particularly those that are highly transmissible, such as measles,” Goad said.⁴

Vaccine Coverage Remains Unchanged Under Federal Programs

CDC officials have offered reassurances that all recommended vaccines as of December 31, 2025, will remain fully covered under Affordable Care Act plans and federal programs such as Medicaid, the Children’s Health Insurance Program, and the Vaccines for Children program, with no out-of-pocket costs for families. As a result, US insurance plans will continue to cover a broader range of childhood vaccines than those in many peer nations, where coverage is typically limited to recommended immunizations.³

“It’s important to emphasize that HHS has stated there will be no changes in insurance coverage for vaccines moved into shared clinical decision-making or high-risk categories. Vaccines covered under Medicaid, the Children’s Health Insurance Program, the Vaccines for Children program, and private insurance are expected to remain covered,” Goad said.⁴

Sparkman expressed concern that changes affecting managed Medicaid plans could disproportionally impact vulnerable populations already facing significant social determinants of health. She warned that placing additional burdens on providers who care for Medicaid patients could jeopardize patient safety and quality of care.⁷

Pharmacists Play a Key Role Amid Vaccine Uncertainty

As the first point of care for many patients, pharmacists are uniquely positioned to provide trusted, evidence-based guidance to families and help provide evidence-based care during this period of uncertainty.

“What has happened in this administration is such a change from practice and how pediatricians operate in their practices and clinics. They relied on the federal administration and the CDC to deliver what used to be open and transparent science and guidance, and that has changed. There are a lot of personal opinions and nonscience information driving some of these changes, and from what I can see, physicians are just not having it,” Sparkman concluded.⁷

REFERENCES

1. Mandavilli A. Kennedy scales back the number of vaccines recommended for children. New York Times. January 5, 2026. Accessed February 13, 2026. https://www.nytimes.com/2026/01/05/health/children-vaccines-cdc-kennedy.html?unlocked_article_code=1.CFA.Xapy.XwXgFI7UEUTJ&smid=url-share

2. McGovern G. Federal health officials scale back number of recommended vaccines for children. Pharmacy Times. January 5, 2026. Accessed February 13, 2026. https://www.pharmacytimes.com/view/federal-health-officials-scale-back-number-of-recommended-vaccines-for-children

3. Fact sheet: CDC childhood immunization recommendations. US Department of Health and Human Services. Updated January 5, 2026. Accessed February 13, 2026. https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html#

4. Goad J, Halpern L. Q&A: expert warns of public health risks after childhood vaccine schedule changes. Pharmacy Times. January 20, 2026. Updated February 2, 2026. Accessed February 13, 2026. https://www.pharmacytimes.com/view/q-a-expert-warns-of-public-health-risks-after-childhood-vaccine-schedule-changes

5. AAP Immunization Schedule. American Academy of Pediatrics. February 5, 2026. Accessed February 13, 2026. https://publications.aap.org/redbook/resources/15585/?autologincheck=redirected

6. Berg S. Pediatric vaccines: questions parents will ask—and how to answer. American Medical Association. January 28, 2026. Accessed February 13, 2026. https://www.ama-assn.org/public-health/prevention-wellness/pediatric-vaccines-questions-parents-will-ask-and-how-answer

7. Sparkman L, Ferruggia K. Q&A: a growing divide between federal vaccine policy and clinical practice. Pharmacy Times. February 12, 2026. Updated February 13, 2026. Accessed February 13, 2026. https://www.pharmacytimes.com/view/q-a-a-growing-divide-between-federal-vaccine-policy-and-clinical-practice

8. 2025 measles outbreak. South Carolina Department of Public Health. Updated February 13, 2026. Accessed February 13, 2026. https://dph.sc.gov/diseases-conditions/infectious-diseases/measles-rubeola/2025-measles-outbreak

9. Rosenbluth T. Oz offers forceful call for vaccination as measles becomes more dire. New York Times. February 9, 2026. Accessed February 13, 2026. https://www.nytimes.com/2026/02/09/well/dr-mehmet-oz-measles-vaccine.html#selection-4481.0-4481.68