In a sweeping shift that has sent shockwaves through the American public health community, the United States has ended its longstanding universal recommendation for four childhood vaccines, including the annual flu shot. The move, approved on January 5, marks one of the most significant changes to the country’s childhood immunisation policy in decades and advances a long-held goal of Health Secretary Robert F. Kennedy Jr., a prominent critic of broad vaccine mandates.
The revised guidance removes the blanket recommendation that all children receive vaccines for influenza, rotavirus, meningococcal disease, and hepatitis A. Instead, parents are now advised to make decisions in consultation with healthcare providers under a framework described as “shared clinical decision-making.” While immunisations for 11 other diseases, including measles, mumps and varicella, remain universally recommended, experts warn the rollback could have serious consequences.
“This is not a minor adjustment — it is a fundamental rethinking of how we protect children from preventable diseases,” said Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “There should have been a transparent, public discussion about the risks and benefits before making a change of this magnitude.”
A Decision Without the Usual Safeguards
What has particularly alarmed public health professionals is how the change was made. The revised guidance was approved by CDC Acting Director Jim O’Neill without the agency’s customary review by independent outside experts — a process that has long been considered central to maintaining scientific credibility and public trust.
The shift aligns closely with Kennedy’s broader campaign to pare back childhood vaccinations. In the past, he has questioned the safety of vaccines and promoted links to autism that have been repeatedly disproven by extensive scientific research.
President Donald Trump, who last month urged the US to “align with other developed nations” by reducing the number of childhood shots, celebrated the announcement. Calling the new schedule “rooted in the Gold Standard of Science,” Trump praised Kennedy and health officials in a post on Truth Social.
“Many Americans, especially the ‘MAHA Moms,’ have been praying for these common sense reforms for many years,” Trump wrote, referring to Kennedy’s Make America Healthy Again movement.
Experts Warn Children Are at Risk
Medical experts, however, paint a far more cautious picture. Dr. Sean O’Leary, chair of the American Academy of Pediatrics, stressed that international comparisons can be misleading.
“Other developed countries face different disease risks and operate under universal healthcare systems,” O’Leary said. “In the US, where care depends heavily on private insurance, removing universal recommendations could widen disparities and leave many children unprotected.”
The Department of Health and Human Services said its decision was informed by a review of immunisation policies in 20 developed countries, all of which provide government-funded healthcare. The review found that flu shots are universally recommended in only four of those countries, while hepatitis A vaccination is universal only in Greece. Rotavirus and meningococcal vaccines, however, remain broadly recommended abroad.
For critics, those figures raise an obvious question: why drop universal guidance in the US when many peer nations continue to recommend the same vaccines?
The Stakes Behind the Shots
Each of the four vaccines now shifted into the “shared decision-making” category targets diseases that once caused widespread illness, hospitalisation and death among children.
“Flu vaccines save lives,” said Dr. Jesse Goodman, a Georgetown University professor and former FDA chief scientist. “In the 2024–25 season alone, influenza killed 288 children in the United States.”
Rotavirus, which causes severe diarrhoea and dehydration, used to send tens of thousands of children to hospitals every year before vaccination made such cases rare. Hepatitis A, while often resolving on its own, can lead to hospitalisation and long-term liver damage. Meningococcal disease, though uncommon, can be deadly — with about 15% of infected children dying despite antibiotic treatment, Goodman noted.
“If you can safely prevent it, it makes total sense,” he said.
What Remains — and What Changes
The updated schedule still maintains universal immunisation against diseases such as measles, mumps and chickenpox. Insurance providers will continue to cover vaccine costs regardless of whether shots are universally recommended or subject to shared decision-making, senior HHS officials said.
The guidance also introduces another notable change: US children are now advised to receive a single dose of the HPV vaccine, instead of the traditional two-dose course. Supporters cite recent studies and World Health Organization backing, while vaccine manufacturer Merck has warned that US regulatory approval still reflects a two-dose regimen.
A Turning Point for US Vaccine Policy
Supporters of the new approach argue it empowers parents and aligns America with global norms. Critics counter that it risks undermining decades of progress in reducing preventable childhood diseases.
“This decision shifts the burden from public health systems onto individual families,” said Osterholm. “History shows us what happens when vaccination rates drop — and it’s not something we should be eager to repeat.”
As the US enters a new chapter in its immunisation policy, the debate highlights a deeper divide over science, trust, and the role of government in protecting children’s health — a divide that is unlikely to close anytime soon.
