What do the new U.S. vaccine recommendations mean for parents and children?

UCBPH: What was your reaction to the announcement?

Charles Whittaker: What struck me most was how much this process felt like it happened in the dark. You know, major changes to a national immunization schedule do happen. We update in light of new evidence all the time. But the changes are usually debated in public with input from pediatricians, immunologists, epidemiologists and other clinicians—and we just didn’t see that kind of open process here. We didn’t see those types of deliberations, or an accompanying evidence summary that the public can scrutinize, in a way that this type of situation demands.

So CDC’s policy change— the cutbacks to the recommended children’s vaccine schedule—is worse, or harder to accept, for being made behind closed doors?

Yes—and I don’t support or endorse either this decision or the way it was made.

When those types of decisions aren’t made in excruciating daylight, it becomes very, very hard—understandably—for families to trust them. And I think that really speaks to why process matters in public health—that process isn’t just a bureaucracy. It serves as checks and balances in part, but it’s really about how we protect scientific rigor and let in independent experts.

Has the evidence on vaccine safety changed?

The biggest point here is, let’s be clear, the underlying science hasn’t changed [emphasis added].

The vaccines have been rigorously tested. Their safety and effectiveness have been affirmed through decades of real-world use and ongoing monitoring, as well as a suite of gold standard trials that underpinned their development in the first place—the entire prior childhood adolescent schedule was built on that evidence base.

Departing from that standard risks fundamentally preventable deaths, because we will see outbreaks of infectious diseases that are vaccine-controllable—and that would continue to be vaccine-controllable if folks were vaccinated. And when fewer people are protected, we don’t just increase risk for individuals, we also lose some of the herd immunity that keeps outbreaks from taking off in the first place.

What did you think of the comparisons that federal health officials made to childhood vaccine schedules in other industrialized countries?

I’m very cautious about simple comparisons to other countries’ schedules.

Infectious disease risk, healthcare access, and the ability to reliably screen and follow up vary a lot between countries and within the U.S. What works in a smaller system with universal access [to healthcare] doesn’t automatically translate to a large, diverse population with uneven care. U.S. policy should be grounded in considerations of U.S. epidemiology, the U.S. healthcare system, and the U.S. population.

For example, the U.S. healthcare system is incredibly fragmented. Denmark has universal healthcare access. They have population-based registries so that all children are tracked. I have collaborators who work in Denmark. The data is incredible and enables them to very meaningfully support a completely different modality of healthcare than is possible in the U.S.—so all of that, and the ability to reliably screen and follow-up varies a lot between countries, and even within the U.S. And what works in a smaller system with universal access doesn’t automatically translate to a large, diverse population with uneven care.

What do you say to parents who are worried about getting vaccines that are off the recommended list?

You haven’t lost access to any of the vaccines. They aren’t being taken off the market. If you and your clinician agree that a vaccine makes sense for your child, you should still be able to get it without paying out of pocket.

Where should parents look for expert advice?

My general advice is not to interpret a change in how a vaccine is characterized as new evidence that it is unsafe or unnecessary. If your family has been vaccinating on schedule, there’s no scientific reason to stop doing that now. The American Academy of Pediatrics (AAP) is a good place to continue looking and learning.

What exactly is shared clinical decision-making?

It’s CDC’s term for a conversation between you and a clinician about your child’s risks and exposures. What this means, in practice, is that parents might need to be more proactive than before at healthcare visits, especially when asking about vaccinations. In real life, when something—say, a vaccination—moves out of the “routine” bucket, it can get less airtime in a busy clinic. What this means is parents may need to ask directly, “Are we following the AAP schedule, and are there vaccines we should still do even if they’re not universal on the CDC list?”

It’s possible some of these might slip through the net unless parents are actively raising it with their physician.

How do I know if my child is high-risk for any of the diseases that won’t now be on the recommended list for vaccines?

This is a big challenge as what makes a child “high risk” isn’t always obvious in advance. RSV is a good example: Multiple analyses have found that a large share of infants hospitalized with RSV were full-term and previously healthy, which is exactly why simple risk-stratification can miss people. So I encourage families to treat high-risk as a prompt for a careful conversation with your physician—not a label you can confidently self-assign at home and thus preclude any conversation from taking place.