The US Department of Health and Human Services (HHS) has accepted recommendations to update the nation’s childhood immunization schedule, aligning its schedule with that of Denmark. Deputy Secretary of HHS Jim O’Neill, who is serving as acting director of the Centers for Disease Control and Prevention (CDC), signed a decision memorandum formally adopting the recommendations, which stem from a presidential directive. The directive instructed federal health leaders to assess how peer nations structure childhood vaccination schedules and determine whether superior approaches exist abroad while preserving Americans’ access to currently available vaccines.1
“After reviewing the evidence, I signed a decision memorandum accepting the assessment’s recommendations,” O’Neill said in a statement.1
The assessment examined immunization policies across 20 peer high-income nations, analyzing clinical and epidemiological evidence, vaccine uptake, public trust, mandates, and knowledge gaps.1
Up until this change, the US recommended childhood immunizations for 18 diseases (including respiratory syncytial virus [RSV] if mothers have not been vaccinated while pregnant). The statement released this afternoon noted that Denmark vaccinates against 10 diseases.1
“We don’t follow Denmark’s vaccine recommendations because we don’t live in Denmark. Children in the United States are at risk of different diseases than children in other countries," José Romero, MD, FAAP, member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, said in a statement. "We also have a completely different health system. The bottom line is vaccine recommendations in the United States are designed to help children resist serious illnesses so they can stay healthy, and our communities can stay healthy."2
On its website, the AAP has disputed the federal guidance and fact-checked claims made by HHS and the CDC.
Statement from National Foundation for Infectious Diseases (NFID)
The influenza vaccination is another of the vaccines moving from a universal recommendation to “shared clinical decision-making.”
Robert Hopkins, MD, medical director, NFID, offers this perspective in this statement:
"Comparing the US childhood immunization schedule to that of Denmark or other countries ignores fundamental differences in population size, diversity, healthcare access, and infectious disease risk. These differences matter. U.S. immunization policies must be guided by a transparent, evidence-based process and grounded in US epidemiology and real-world risk. As we are already seeing signs of a severe respiratory season, this is not the right time to make changes that are not supported by clear evidence. Last flu season, 280 US children died from influenza—the highest toll in more than a decade. RSV remains the most common cause of hospitalization among U.S. infants. The National Foundation for Infectious Diseases strongly recommends annual flu vaccination for everyone age 6 months and older, and RSV vaccination for all infants whose mothers did not receive an RSV vaccine during pregnancy. Adopting an immunization schedule designed for another country could put US children at risk for serious, preventable diseases."
Under the updated framework, the CDC will continue organizing vaccines into 3 categories, which must all be covered by insurance without cost sharing. The categories include:
Vaccines recommended for all children. Vaccines in this category will include those protecting against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type b, pneumococcal disease, human papillomavirus, and varicella.3
Vaccines for specific high-risk groups. The immunizations recommended for this group are the RSV, hepatitis A, hepatitis B, dengue, meningococcal ACWY, and meningococcal B vaccines.3
Vaccines offered through shared clinical decision-making. The immunizations in this category are for rotavirus, COVID-19, influenza, meningococcal disease, hepatitis A, and hepatitis B.3
Whereas this last category was part of recommended federal guidance, this new shared clinical decision-making category suggests these vaccines may not be required or needed for everyone.
HHS and the CDC will work with state health agencies, physician organizations, and other partners to implement the updated schedule and educate clinicians and families nationwide.
Additionally, AAP added information from a previous CDC report. “Among children born [in the United States] during 1994-2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, resulting in direct savings of $540 billion and societal savings of $2.7 trillion.”2
Our editor in chief, Jason Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS, wrote about the massive changes going on within public health policy in our current issue. Read his article here.
References
1. CDC acts on presidential memorandum to update childhood immunization schedule. News release. US Department of Health and Human Services. January 5, 2026. Accessed January 5, 2026.
https://www.hhs.gov/press-room/cdc-acts-presidential-memorandum-update-childhood-immunization-schedule.html
2. Fact checked: U.S. vaccine recommendations are appropriate for children in the United States. American Academy of Pediatrics. Accessed January 5, 2026.
https://www.aap.org/en/news-room/fact-checked/fact-checked-u.s.-vaccine-recommendations-are-appropriate-for-children-in-the-united-states
3. Fact sheet: CDC childhood immunization recommendations. US Department of Health and Human Services. Updated January 5, 2026. Accessed January 5, 2026.
https://www.hhs.gov/press-room/fact-sheet-cdc-childhood-immunization-recommendations.html
