The Trump administration is weighing changes to the government’s recommended vaccine schedules that experts say would, if adopted, have far-reaching consequences for public health.
Last week the Department of Health and Human Services posted a request for public input on how vaccines are categorized. Under the current policy, vaccines are assigned to one of three different categories: Some shots are recommended for all children and adults, while others are recommended for at-risk individuals. And some are categorized as recommended based on shared clinical decision-making with a doctor.
The request for comment is hot on the heels of President Donald Trump’s executive order aimed at limiting childhood vaccinations and overhauling their administration. The order, which called for breaking up the combined measles, mumps and rubella (MMR) vaccine into separate shots, has been widely criticized by health experts as a move that was not based on scientific evidence and that is likely to result in fewer children being vaccinated against preventable diseases.
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According to a notice posted in the Federal Register, HHS is considering new categories for vaccines, such as “recommended, but not during infancy” or “recommended with qualification,” although it’s unclear what these designations might mean. The wording in the notice suggests the department is considering changes based on the “strength of the evidence” for certain vaccines and the benefit to individuals and the broader population, as well as “individual circumstances and values.”
“HHS is laying the groundwork for having fewer vaccines be routine, and more may be placed into conditional, individualized or age-delayed categories,” says David Mandell, a professor of psychiatry at the University of Pennsylvania.
Vaccines on the childhood vaccination schedule have been tested in clinical trials against placebos or comparison groups, according to the American Academy of Pediatrics (AAP). And after a vaccine is approved, it goes through additional testing to assess its real-world performance and identify any rare side effects, Mandell says.
“I think HHS is attempting to sow confusion about what constitutes ‘evidence,’” Mandell adds. Moving a vaccine from one category to another or changing how each category is described could mean health care providers would not obliged to remind patients to receive a vaccine at appointments—and add to any hesitation parents might feel about getting their kids vaccinated, he says. “In other words, HHS would not need to remove a vaccine from the schedule to substantially reduce its use,” Mandell says. “Changing the recommendation category could do that.”
It’s the latest move by Secretary of Health and Human Services Robert F. Kennedy, Jr., a longtime vaccine skeptic, to overhaul the nation’s vaccine regimen. In January the Trump administration said it would reduce the number of vaccines recommended for children, but it was blocked in March by a lawsuit led by the AAP.
In response to a request for comment, the AAP said the organization was discussing HHS’s latest request for information internally and that it would submit a formal response through the government’s public portal. The public has until September 20 to comment.
When reached for comment, HHS pointed Scientific American to the department’s public announcement about the request for information (RFI) but didn’t respond to a request for additional information.