The United States ended on Monday its longstanding guidance that all children receive vaccines against flu and three other diseases, a sweeping change that advances one of Health Secretary Robert F. Kennedy Jr.'s longterm goals.
Public health experts warn the latest rollback could lead to preventable hospitalizations and deaths.
The action, approved by Acting Director Jim O’Neill of the Centers for Disease Control and Prevention without the agency’s usual outside expert review, advances Kennedy’s campaign to pare back childhood vaccinations.
Last month President Donald Trump urged the U.S. to “align with other developed nations” by reducing the number of shots for children.
Kennedy, a prominent vaccine skeptic, has previously led efforts to drop universal recommendations for COVID-19 and hepatitis B shots for children, citing links to autism that scientists have repeatedly debunked.
The action removes the recommendation for rotavirus, influenza, meningococcal disease and hepatitis A, and states that parents should consult healthcare providers under what it calls shared clinical-decision-making.
Vaccine experts decried the changes they said put American children at risk.
Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said that there should have been public discussion on the risks and benefits of the potential impact of dropping the recommendations.
Dr. Sean O'Leary, chair of the American Academy of Pediatrics, said that the other developed countries face different disease risks and have different healthcare systems than the United States does. Unlike the U.S., which depends on private healthcare, most countries provide basic universal healthcare that is paid for by the government.
"Any decision about the U.S. childhood vaccination schedule should be grounded in evidence, transparency and established scientific processes, not comparisons that overlook critical differences between countries or health systems," he said.
White House spokeswoman Karoline Leavitt on X described it as a move that would empower parents and physicians to make the best individualized decisions for children while also restoring much-needed confidence in the public health system.
For the change in policy, two leading officials of the Department of Health and Human Services, Martin Kulldorff and Tracy Beth Hoeg, reviewed vaccine protocols in 20 other developed countries - all of which have universal healthcare - and made the recommendations to change the U.S. schedule, the agency said.
In a report, HHS wrote that the level of risk varies by disease and child.
The vaccine schedules of the 20 reviewed countries show that the flu shot is recommended universally in four countries and a shot against hepatitis A is universal only in Greece. The rotavirus shot is recommended for all children in 17 countries and shots against meningococcal disease are recommended in 16 of the countries.
Each of the four vaccines prevents diseases that once caused unnecessary hospitalizations and death in children, said Dr. Jesse Goodman, a Georgetown University professor and former FDA chief scientist.
For example, flu shots can help prevent pediatric deaths from flu, which killed 288 children in the 2024-25 season, according to the CDC. Hepatitis A, which infects the liver, usually resolves on its own but can lead to hospitalization and lifelong liver damage.
Rotavirus, which causes severe diarrhea and dehydration, used to send tens of thousands of children to the hospital each year, but vaccines have made this extremely rare, Goodman said.
While meningitis - a bacterial infection of the brain - is rare in children, some 15% of those infected do not respond to antibiotics and die, he said. "If you can safely prevent it, it makes total sense."
The updated recommendations maintain immunizations for 11 diseases, including measles, mumps, and varicella, while categorizing others as either targeted for high-risk groups or subject to the shared-decision-making category, HHS said.
Insurance providers will continue covering immunization costs regardless of the category, senior HHS officials told reporters on a call.
The new schedule also recommends U.S. children receive a single dose of human papillomavirus (HPV) vaccine, rather than a two-dose course. Recent studies have concluded that a single dose is not inferior to the longer course and noted the World Health Organization also backs a single dose schedule.
Merck, which makes the only U.S. approved HPV vaccine Gardasil, was not immediately available for comment. The drugmaker has said in the past that since there is not sufficient data for the U.S. FDA to license the shot as a single-dose regimen, the CDC's recommendations should be in line with the agency's approval.
Merck had $2.4 billion in U.S. sales from Gardasil in 2024. Shares were up less than 1% at $106.84.
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