The White House Takes Another Shot at Changing U.S. Childhood Vaccine Recommendations

A new Executive Order (EO) released by the White House on Monday is the latest in a series of administration actions seeking to change U.S. childhood vaccine recommendations. It follows:

• a presidential memo from last December calling for the U.S. to align its vaccine recommendations with “best practices from peer, developed countries
• a January 5 memo from the Department of Health and Human Services (HHS) adopting a revised federal childhood vaccine schedule that categorized vaccines into three groups – “population-based,” or recommended for all children recommended for certain high-risk groups; and recommended through “shared-clinical decision-making – and reduced the number of vaccines routinely recommended for all children, and
• an EO from May calling on federal agencies to align their actions, regulations, and funding with the revised vaccine schedule. However, a federal judge has temporarily blocked the revised HHS recommendations.

The new EO re-iterates several previously issued recommendations, including that U.S. childhood vaccines should be “aligned with scientific evidence and best practices from peer, developed countries” and that childhood immunizations should fall into the three categories outlined above. As with the January 5 memo, the EO reduces the number of diseases targeted by routine childhood vaccination from 17 to 11 and the number of routine vaccines from 13 to 7. But it also contains new directives, including calling on the HHS Secretary to offer some childhood vaccines such as measles, mumps, and rubella (MMR) as “single vaccines rather than combination products”; aligning vaccine recommendations with findings to be released by a federal panel known as the “HHS Task Force on Safer Childhood Vaccines”; and directing the Attorney General to advance legal actions challenging state laws that conflict with “parental authority, religious freedom, disability accommodations, and equal protection under the law.” 

The administration has indicated these actions are intended to align the U.S. with peer countries, particularly Denmark. Prior KFF analysis has found, however, that Denmark itself is an outlier among “peer” nations, recommending vaccines against 10 diseases while most European countries recommend vaccines for 15 or more. Moreover, the EO’s directive to split the MMR vaccine into separate shots (a policy that could not be put into practice yet as no single component vaccine is currently licensed in the U.S.) would actually cause the U.S. to diverge from the policies of peer, developed nations including Denmark. No European country, Canada, or Australia recommend separate vaccines over combination MMR vaccines (Japan currently recommends a combination measles rubella vaccine and this year began producing MMR for domestic use for the first time in 30 years).

President Trump said in a Monday press conference that the MMR shot can be “quite lethal” and that splitting up and giving the shots over multiple appointments is safer, although there is no evidence to support this claim. When countries have moved away from combination MMR vaccinations in the past, such as Japan beginning in the 1990s, measles, mumps, rubella outbreaks increased – a sobering prospect given the U.S. is already facing a historically high and growing number of measles cases this year.

The EO empowers a HHS Task Force – comprised of federal officials rather than external experts – to assess “timing and sequencing of all core childhood vaccines” and adjust the federal vaccine schedule. This could, in effect, bypass the CDC and its external Advisory Committee on Immunization Practices (ACIP), the traditional vehicles for federal vaccine recommendations, perhaps an attempt to implement administration vaccine priorities that have so far stymied by federal courts. Even so, it is not clear how many U.S. states, which have primary responsibilities in determining which childhood vaccines are required for school entry and other key vaccine policies, would adopt recommendations from this relatively unknown Task Force. In fact, most states – 30 including DC – have already made moves to decouple their vaccine policies from federal government recommendations for one or more childhood vaccines, instead relying on prior recommendations, state recommendations, and/or those of external entities such as American Academy of Pediatrics (AAP). Any recommendations from the Task Force are also unlikely to change how insurance covers childhood vaccinations given that private insurers have pledged to maintain existing childhood vaccine coverage through the end of 2027, and coverage through federal programs such as Vaccines for Children are not expected to change even with the recategorization of childhood vaccines contained in the order, a point confirmed by the White House itself on Monday.

Given ongoing legal challenges to the administration’s vaccine actions and declining influence of federal recommendations on states vaccine policy decisions, it is not clear how much the new EO can shift U.S. vaccine policy. Still, it could sow further confusion among parents already distrustful of federal guidance, and serve to exacerbate the existing partisan divide in the country on vaccine policy, and prove to be unpopular. A KFF poll from January this year, after HHS announced its earlier changes to the federal childhood vaccine schedule, found that adults who had heard about those changes were twice as likely to say it would have a negative impact on children’s health than a positive one. Ultimately, the effect of implementing these changes could be to raise the risk for further outbreaks of childhood diseases such as measles.