Healthcare policy and vaccine experts are voicing concern about recent Department of Health and Human Services (HHS) overhauls to the childhood vaccination schedule. Of particular interest is how states, some whose vaccine policies have fallen along party lines, will interpret the schedule changes.
The CDC sets the childhood vaccination schedule based on Advisory Committee on Immunization Practices (ACIP) recommendations, but states and local jurisdictions control many childhood vaccine and school entry vaccine policies. Many states benchmark ACIP recommendations to establish school entry requirements, which may be eroded depending on states’ interpretation, said L.J. Tan, chief policy and partnership officer at Immunize.org.All states and Washington require MMR, DTaP, polio, and varicella vaccinations for entry; some states also require hepatitis A, hepatitis B, meningococcal, and/or HPV vaccines. As of May 2024, none of the states nor D.C. have a COVID-19 vaccine entry requirement.
Tan noted the divisive nature of vaccines and vaccination. Immunize.org’s aim is to remove barriers to vaccination.
“Vaccines were never a partisan issue until COVID-19,” Tan said.
But a Kaiser Family Foundation brief explains that 23 of the 26 states that updated their vaccine policies in anticipation of schedule changes have Democratic governors, an example of how party affiliation could color states’ interpretations of the politically-driven schedule changes, as differences in vaccine belief systems continue to bear out in opinion research.
The 2025 KFF and Washington Post Survey of the Parents found 52 percent of all parents think the government recommends “about the right amount” of childhood vaccines in contrast with 41 percent of Republican parents and about half of Republican MAGA-loyal parents who said there are too many vaccines.
Yet, South Carolina had recorded approximately 300 measles cases as of Jan. 9; and Arizona and Utah hit 214 and 176 cases respectively. And Centers for Disease Control and Prevention (CDC) records show in 2025 there were 2,144 confirmed measles cases, the most since 1992. More than 90 percent of the cases were either unvaccinated or an unknown vaccine status.
The new schedule lists some vaccines, like influenza, as “shared clinical decision-making ,” which the CDC describes as “a decision process between the health care provider and the patient or parent/guardian.” The change comes amid the more than 120,000 influenza hospitalizations and 5,000 deaths, including nearly 300 children in 2025, so far during the 2025-2026 flu season.
And while shared clinical decision-making is not new, some say the emphasis on it in the new schedule is seeding confusion.
“All providers have practiced SCDM since the dawn of immunizations. So, this has always been happening. Now parents are going to get confused and ask, ‘What changed?’ But the evidence has not changed,” Tan said.
The ensuing chaos has focused Tan’s attention on states’ coverage of SCDM vaccines, which will affect vaccine uptake.
Paul Offit, who runs the Vaccine Education Center at Children’s Hospital of Philadelphia, fears doctors will second-guess administering flu, COVID, meningococcal, or Hep A or B vaccines despite the American Academy of Pediatrics (AAP) recommending otherwise.
“This could happen to a small degree because they hear “federal government,” or “CDC”, and think this decision is based on good data. When in fact these decisions were made behind closed doors by federal appointees without public comment,” Offit said.
The 80-year-old Administrative Procedures Act requires federal officials to follow an open process when changing rules and regulations, and prohibits officials from making “arbitrary and capricious” decisions. Scholars expect the Trump administration will face legal challenges since officials continue to skirt a longstanding law in place to ensure transparency.
