The CDC follows RFK Jr.’s vax lead, but what do the new changes mean?

Health and Human Services Secretary Robert F. Kennedy Jr. has stirred controversy over the years with his opinions about childhood vaccinations. So when the Centers for Disease Control — under Kennedy’s direction — announced last week that it is recommending a pared-down vaccine schedule, it was bound to raise a hue and cry.

The changes slash the number of childhood vaccinations the CDC recommends from 17 to 10. (Some shots cover more than one disease.)

Media coverage of the announcement focused on the reaction from medical organizations, which was overwhelmingly negative. But scant attention was paid to what the changes really mean.

What’s still in?

The CDC still recommends that all children receive vaccinations against the most notorious diseases: diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, and chicken pox.

What’s out?

Vaccines for RSV, hepatitis A and B (typically given shortly after birth), dengue, and two forms of meningitis are now recommended only for children in high-risk groups. The CDC said the vaccines for Covid, flu, and rotavirus should be a shared decision between parents and doctors.

No vaccines were downgraded to “not recommended.”

What does it mean to be out?

The CDC changes should not affect the availability of any vaccines. The Health and Human Services Department (HHS) also clarified that coverage for vaccinations by government-funded medical insurance programs will not change at all.

State requirements for school admittance remain unaffected, and individual physicians may continue to recommend all the same vaccines.

The only thing that has changed is that the CDC now says vaccinations on the “out” list should no longer automatically be given to healthy children as a matter of routine medical care.

What do doctors think?

The CDC move was panned by health experts and organizations, including the American Academy of Pediatrics, which called the changes “dangerous and unnecessary.”

“Parents are going to have to know enough to ask and understand the consequences of their child not being vaccinated,” said Dr. William A. Petri, infectious disease professor at the Virginia School of Medicine. “It’s rare, but every year there are children who die from influenza. Why should even one child die of a vaccine-preventable illness?”

What is the medical world afraid of?

Many medical experts worry that leaving more vaccinations open to dialogue will lead to a downturn in vaccination rates and increases in childhood illnesses.

There is data to back up their argument. For example, the CDC’s own estimates state that immunization against the rotavirus stomach infection prevents over 40,000 hospitalizations annually.

Before vaccination at birth was introduced for hepatitis B around 30 years ago, 20,000 babies were infected yearly. That number is now down to about 20.

Dr. Jeffrey Singer, a surgeon who serves as a senior fellow at the Cato Institute’s Department of Health Policy Studies, shares apprehensions about slashing certain vaccines from the list, but acknowledges that politics likely plays a role in the level of vehemence in opposition: “Unfortunately, this is such a polarized society that if someone who’s part of the group that you’re not sympathetic with says something, all of a sudden, you have to be against it.”

Why change?

In justifying the change, the CDC announcement cited comparisons of US vaccine recommendations to those of European countries, and stated that America had become a “global outlier.” For example, no European nations recommend a Covid vaccine for children, and few automatically give flu shots. Yet European vaccination rates and levels of childhood illness are similar to those in the United States.

The main motivation for the change, according to the CDC, was a perceived need to “rebuild trust in public health,” which took a nosedive during the Covid pandemic. The CDC quoted cited poll data showing that between 2020 and 2024, confidence in the health care system dipped from 71.5% to 40.1%. Vaccination rates fell significantly during the pandemic. They have since rebounded, but not to pre-2020 levels. Trump administration officials argue that offering people more autonomy will raise both levels of trust and immunizations rates.

Dr. Singer stresses his belief as a physician that, except for the one for Covid, the vaccines that dropped off the CDC recommended list are still important for children.

But he agrees that as a matter of policy, it’s good for the CDC to do less dictating: “Unless you’re threatening the lives of those around you, these matters should be left up to individual people to make together with the experts they know and trust.”

Mr. Kennedy’s well-known skepticism toward vaccines was not mentioned at all in the CDC’s official statement. But perhaps due to the notoriety of his views, there was no shortage of accusations that his attitude played a role in the changed guidelines.

Healthy as a Dane

The CDC’s stated goal was to bring the US vaccine schedule within the range of other Western countries. The US schedule now mirrors that of Denmark, with the exception that the US still recommends the chicken pox vaccine.

The level of vaccine participation and childhood illness in Denmark is roughly in line with where the US was pre-2020. Yet critics say that nation’s population — smaller and more homogeneous — make it a poor model to follow.

Dr. Petri questions why the US, with its more robust medical research infrastructure, should look abroad for ideas.

“I think we should be leading with vaccines for preventable illnesses,” he says. “We don’t look to Europe for our policies on other things, and we shouldn’t. Why should we do it for the health of our children?”

More trust or more illness?

For decades, the CDC recommendations were authoritative for both states and medical organizations. With the HHS now under Mr. Kennedy’s leadership, that has changed. In the wake of last week’s CDC announcement, several state health departments said their guidance would remain the same.

Dr. Petri says a disconnect between states and the CDC would be unfortunate, given the positive impacts of what has been a close working relationship. He specifically pointed to the sharing of epidemiology intelligence and to joint outbreak investigations.

Dr. Singer, however, argues that the federal government’s role in health policy had grown too big. He was optimistic that the divide between physicians and some states on one hand and the CDC on the other might strike a better balance.

“The CDC should have never been in this business,” he says. “Dense urban populations with people bringing diseases from other parts of the world need different health advice than a rural state. A silver lining to this might be if people hear all this controversy, the CDC becomes less important, and people turn to their local experts. That leaves more room for pluralism and discussion, less feeling that somebody’s trying to impose their view. In the long run, that should foster more trust.”

(Originally featured in Mishpacha, Issue 1095)