A New Era for Childhood Vaccine Policy

The United States faces its worst measles outbreak in decades. As states around the country scramble to respond, state leaders clash with federal health authorities, who have reportedly downplayed the severity of the outbreak. The outbreak also comes as the longstanding national framework for childhood vaccine recommendations is unraveling.

During the 2024 U.S. presidential campaign, Donald J. Trump suggested that he would overhaul federal vaccine policy if elected. U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., has questioned both the safety and effectiveness of childhood vaccines.

Kennedy has since replaced every member of the Advisory Committee on Immunization Practices (ACIP), a panel of experts that advises the Centers for Disease Control and Prevention (CDC) on vaccine schedules. The CDC has historically considered ACIP’s recommendations when publishing its recommended immunization schedule for children.

Earlier this year, the CDC published an updated childhood vaccine schedule that reduced the number of recommended vaccines from 17 to 11. In a departure from longstanding practice, the CDC issued the new schedule without input or a recommendation from ACIP.

Alongside the updated vaccination schedule, the Administration released an assessment of U.S. childhood vaccine policy. In the assessment, policy experts from the U.S Food and Drug Administration and the CDC compared U.S. vaccine policy with that of other developed countries. They noted that the United States recommends more childhood vaccines than peer countries, measured by both the number of diseases covered and the total number of recommended doses.

The experts also emphasized that peer countries rely less on vaccine mandates and more on voluntary compliance. According to the experts, vaccine mandates undercut trust in public health authorities.

Some doctors and public health organizations criticized the assessment and the revised vaccine schedule. The American Academy of Pediatrics (AAP), a private, nonprofit organization, sued to block the new schedule from taking effect, and a federal judge in Massachusetts blocked the schedule in March, preventing its implementation. The Administration appealed that decision, and the appeal remains pending.

In response to the federal changes, more than two dozen states announced that they will no longer follow ACIP or CDC guidelines for childhood vaccines. After the CDC released its new schedule, the AAP published its own recommendations for childhood vaccines. Other private medical organizations, including the American Medical Association and the American Academy of Family Physicians, endorsed these recommendations. Some states have also formed health alliances to coordinate vaccine and public health policy independently of federal guidelines, and these states have said they will follow the AAP’s recommendations.

Other states, however, have adopted approaches consistent with the Trump Administration. In 2025, Idaho became the first state to ban vaccine mandates in businesses and schools. In August, the Florida Department of Health issued a proposed rule that would remove requirements for several common vaccines from school immunization rules and strengthen protections for religious exemptions. Other states have also expanded or reaffirmed protections for religious exemptions to vaccine requirements.

In this week’s Saturday Seminar, scholars and policy analysts critique the current U.S. childhood vaccine framework and offer ideas for improvement.

• In a Health Affairs article, Patricia Pinckombe argues that U.S. childhood vaccine policy should not be modeled on policies in peer countries such as Denmark. Pinckombe notes that Denmark has a single-payer, universal health care system that provides consistent health care coverage and access nationwide. In the fragmented U.S. health care system, however, large gaps in insurance coverage and access to care exist, Pinckombe explains. She argues that a broader recommended vaccine schedule helps minimize the impact of these gaps. Pinckombe also notes that Denmark’s small population and universal health care diminish the risks of severe disease outcomes, but in the United States, access gaps and different patterns of disease transmission create more need for preventive vaccine policy.
• James Hodge of Arizona State University’s Sandra Day O’Connor College of Law examines how widespread misconceptions about vaccine safety and the legal framework governing vaccination may contribute to growing vaccine hesitancy in a Journal of Law, Medicine & Ethics article. Hodge outlines 10 common vaccine legal myths, exploring topics such as vaccine manufacturer liability, religious and philosophical exemptions, and vaccine mandates. He clarifies that although governments generally cannot compel adults to receive vaccines, states still retain substantial authority to condition access to certain activities, such as school attendance, employment, or travel, on proof of vaccination. He argues that transparency and correcting common misunderstandings about vaccine law are critical to preserving public health protections and counteracting distrust of government.
• In a report for the America First Policy Institute, Policy Fellow Brandon J. Logan argues that childhood vaccine mandates are inconsistent with parents’ constitutional right to make authoritative decisions about their children’s medical care. Logan citesS. Supreme Court decisions holding that parents have a fundamental right to make decisions about their children’s education, custody, and medical care. He acknowledges that states have the power to address dangerous public health crises but cautions that this power is limited and states can act only to prevent serious, imminent harm. Logan also maintains that total bans on religious exemptions are likely unconstitutional. He contends that the Administration’s vaccine schedule reform will better protect parental rights and ensure trust in public health authorities.
• In an article in the Journal of the American Medical Association Health Forum, Georgetown University Law Center’s Lawrence O. Gostin and health care attorney Richard Hughes IV contend that challenges to longstanding vaccine requirements—particularly those that seek constitutionally mandated religious exemptions—can weaken state authority to protect populations against preventable disease. They argue that a recent wave of vaccine-related litigation, led in large part by Kennedy, raises questions about the independence of scientific advisory bodies and threatens longstanding deference to public health. Succumbing to pressures to prioritize religious exemptions over herd immunity—the protection that widespread vaccination provides to a community—would undermine the shared responsibility for community health, they warn.
• The strength of school vaccination requirements lies in being mundane and routine, writes Tony Yang of the George Washington University Milken Institute School of Public Health, in a JAMA Health Forum article. Yang contends that school vaccine requirements provide guidance and structure to the vaccination process and create important points of contact with the health care system for many families. Yang argues that these requirements are a vital part of public health infrastructure with broad consent and recommends designing requirements that families view as legitimate and can meet without barriers. According to Yang, immunization requirements work because they become routine. Portraying them as exceptional invites stronger opposition, he cautions. Yang urges immunization proponents to discuss these requirements as mundane.
• In a Health Affairs article, Ram Koppaka, a health policy consultant and former senior CDC official, argues for greater vaccine policy coordination between the states and the federal government. Federal agencies determine vaccine policy, but states implement it, resulting in a system that Koppaka argues is complex and varies across states. Koppaka contends that the response to the COVID-19 pandemic demonstrated that the vaccination system could provide coordinated, accessible care nationwide. According to Koppaka, the cohesion broke down in 2025 with the scaling back of federal power. Koppaka advocates state and national coordination on vaccine delivery to restore the access achieved during the pandemic and reduce differences among states’ delivery systems.